Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Oct 4, 2019
Date Accepted: Nov 13, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Social media and text messages improve calcium knowledge but not intake in young adults: a three-arm six-week randomised controlled trial with process evaluation
ABSTRACT
Background:
Calcium is an important nutrient for the attainment of peak bone mass during adolescence and young adulthood. However, these life phases are characterised as hard to reach for health promotion. Social media platforms offer a promising channel as they are relatively low cost but used ubiquitously by youth.
Objective:
The aim of the CAN-DO study was to conduct a randomised controlled trial to test the effectiveness of Facebook alone or with text messaging as channels to deliver a theory-based program to encourage optimal calcium intake.
Methods:
The intervention was a three-arm parallel trial. Young adults aged 18 to 25 were recruited through university and social media for a six-week trial. Participants were randomised to one of three arms (Facebook posts; Facebook posts plus text messages; and Control group that received an e-leaflet containing information on calcium intake). The primary outcome was change in intake of milk and other calcium-rich foods and secondary outcomes were knowledge, self-efficacy, motivation and habit formation concerning calcium-rich foods. Changes were assessed before and after the intervention and the differences in change between groups compared using multivariate regression models with multiple imputations for missing data.
Results:
A total of 211 participants (30.3% males) participated (mean age 21.4; SD 2.1). At the end of the program no increase in milk intake (OR 1.51 95% CI 0.61-3.75 Facebook; OR 1.77 95% CI 0.74-4.24 Facebook plus text messages; P=0.4076) nor calcium-rich food was detected (p=0.5686). There was a significant improvement in knowledge in the Facebook plus text message group (P= 0.0004) but habit formation improved less than in the other two groups (P= 0.0127). Our results showed a moderate level of engagement with intervention content and positive qualitative feedback from participants.
Conclusions:
The CAN-DO study delivered via Facebook (with the additional support of text messages) was found to improve knowledge and was acceptable among young adults. However, further research is needed to better understand social media engagement and how to optimise the program for participants to be sufficiently motivated to increase their intake of calcium-rich foods. Clinical Trial: As neither the primary outcome or the secondary outcomes were clinical measurements the study was not entered into a clinical trials registry.
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